Do you eat sugar-laden breakfast cereals, potato or corn chips, cookies, ice cream, candy, or other junk foods on a daily basis?

Yes No

2.

Do you experience sudden and/or frequent cravings for sugar and other high carbohydrate foods?

Yes No

3.

Do you experience
fatigue suddenly or on a daily basis?

Yes No

4.

When you eat sweets, do you again crave them 2-3 hours later?

Yes No

5.

Do you eat meals that largely consist of foods like pasta, rice, potatoes or other concentrated carbohydrates more than 4 times per week?

Yes No

6.

Do you become irritable or cranky if you are either late for or miss a meal, especially breakfast?

Yes No

7.

Do you experience feelings of shakiness, nervousness, or headaches which are relieved by eating sweets?

Yes No

8.

Are you bothered while sleeping by increased perspiration or excessive thirst?

Yes No

Section B

9.

After a stressful day, do you crave sweets at night, or binge on carbohydrate foods?

Yes No

10.

Do you crave and eat sweets, but get no relief from symptoms you are having?

Yes No

11.

Are you more than 15 pounds over your “ideal” body weight?

Yes No

12.

Do you have a family history of low blood sugar, diabetes, high blood pressure, or high cholesterol?

Yes No

13.

Do you exercise infrequently?

Yes No

14.

Do you have a difficult time losing weight even when you do exercise?

Yes No

15.

Do you have low blood sugar, diabetes, high cholesterol, and/or high blood pressure?

Yes No

16.

Do you have excessive weight or fat around your abdominal area (spare tire)?

Yes No

17.

Are you constantly thirsty, and have frequent urination?

Yes No

Section A

Section B

Section A:

• If you answered yes to up to 4 questions, you may be experiencing hypoglycemia, or low blood sugar as a beginning stage to insulin resistance.

• If you answered yes to 5 or more questions, you are probably experiencing some level of insulin resistance.

Section B:

• If you answered yes to up to 4 questions, you may be experiencing a pre-diabetic condition.

• If you answered yes to 5 or more questions, there is a strong possibility that you may be experiencing blood sugar imbalance symptoms.

Disclaimer: This questionnaire is not intended to replace medical advice. It is meant solely as a guide to help individuals determine their relative state of health in regard to blood sugar metabolism. Any time there is any question or concern, it is strongly advised to seek professional medical advice.